Basic Information
| Provider Information | |||||||||
| NPI: | 1992335889 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEISMAR | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3366 JUDILEE DR | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914364210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183910444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7038 OWENSMOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913033198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183478565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2020 | ||||||||
| LastUpdateDate: | 03/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 118007 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 118007 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.